The clinicopathological features and prognostic factors of gastric squamous cell carcinoma

Abstract

Primary gastric squamous cell carcinoma (SCC) is an exceedingly rare disease. We increased the understanding of gastric SCC and evaluated prognostic factors of gastric SCC.In this large-population cohort study, we retrospectively collected 163 primary gastric SCC and 66,209 primary gastric adenocarcinoma cases from the surveillance, epidemiology, and end results program (SEER) database from 1988 to 2012. The Chi-squared test demonstrated the distributed differences. Cox proportional hazards regression model was used to evaluate the prognostic factors.Gastric SCC accounted for 0.2% of all the primary gastric cancer cases. The mean age of patients with gastric SCC was 69.6 years old, and the man-to-woman ratio was 2.3:1. The proportion of black was higher in gastric SCC than gastric adenocarcinoma (P < 0.001). Almost half of the gastric SCCs were diagnosed in stage IV and more than half were poorly differentiated. In gastric SCC, the median survival was 8.0 months and the 5-year overall survival (OS) was 32.7%; in gastric adenocarcinoma the median survival rate was 19.0 months and the 5-year OS was 35.4%. The multivariate analysis showed that number of primary lesions, tumor location, grade, and stage were independent prognostic factors in gastric SCC. The tumor stage was the most important prognostic factor.Primary gastric SCC is exceedingly rare. Compared with gastric adenocarcinoma, gastric SCC was more frequent in black patients and was usually diagnosed when it was poorly differentiated and at a later stage. On the whole, gastric SCC has a poorer outcome. Disease stage is likely a key determinant in survival.

Figure 1

(A) The median survival was 8.0 months and 5-year OS was 32.7% in gastric SCC, 19.0 months and 35.4% in gastric adenocarcinoma. The gastric SCC had a poorer outcome than gastric adenocarcinoma (P < 0.001). (B) The 5-year OS were 80.0%, 67.5%, 39.7%, and 6.0% in the stage I, II, III, and IV subgroups of gastric SCC, respectively, with significant difference (P < 0.001). OS = overall survival, SCC = squamous cell carcinoma.

Figure 2

(A) Abdominal enhanced computed tomography (CT) scan images of a 50-year-old male patient with gastric SCC treated in our hospital showed a mass of 5.0 × 4.8 cm in size in the fundus of stomach, protruding to hepatogastric space. (B) Electronic gastroscopy revealed a gray-white and fragile tumor-like bulge of 4.0 × 4.0 cm in size with irregular surrounding mucosa. SCC = squamous cell carcinoma.